Trypan Blue in Macular Pucker Surgery: An Evaluation of Functional Outcome and Histology

Abstract

Abstract: : Purpose: To report on functional outcome of macular pucker surgery with the use of trypan blue, to evaluate the ultrastructure of tissue harvested during surgery and to compare these findings to results without trypan blue assistance. Methods: Functional outcome (visual acuity, Goldmann perimetry) of 10 eyes of 10 consecutive patients with intraoperative use of trypan blue was prospectively analyzed (group 1) and compared to a matched group of 10 patients (preoperative visual acuity, pre- and postoperative lens status) who former had undergone vitrectomy without trypan blue assistance (group 2). Only patients with an idiopathic macular pucker were included. Surgery consisted of three port pars plana vitrectomy, removal of epiretinal tissue and the ILM in a second step. In group 1 additionally isoosmolaric trypan blue dye (0.15%) was used. Epiretinal tissue of all eyes was harvested and prepared for ultrastructural analysis using light and electron microscopy. Results: Preoperative best corrected visual acuity was 20/50 (median) in both groups (range 20/200 to 20/40). Mean age was 70 years in group 1 and 68 years in group 2. Median follow-up time was 4.0 months in group 1 and 4.5 months in group 2. Postoperatively, in group 1 (with trypan blue) median visual acuity had increased to 20/32 (20/100 to 20/25; Wilcoxon Test: p = 0.011) and in group 2 to 20/40 (20/100 to 20/25; p = 0.093). The difference between both groups was not statistically significant (p = 0.393). No deterioration of visual acuity and no postoperative visual field defects were noted after trypan blue-assisted surgery. Histological analysis revealed intact epiretinal cells with interspersed collagen. In some section areas of cellular elements were detected adjacent to the retinal surface of the ILM. Conclusions: Trypan blue-assisted surgery for macular pucker leads to good functional results. It allows a better intraoperative visibility especially of the borders of the epiretinal membrane. Compared to our standard surgical procedure we did not observe any adverse effects on functional outcome associated with the concentration applied in our patients.

Keywords: vitreoretinal surgery • retina • macula/fovea